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Surgery is an important part of treatment for most types of bone cancer. It typically includes:

• Biopsy to diagnose the cancer
• Surgical removal of the tumor(s)

Note: This information focuses on bone cancers that are seen most often in adults and start in the bones (primary bone cancers). Osteosarcoma, Ewing sarcoma, and bone metastases are covered separately.

Biopsy and tumor removal surgery

Whenever possible, it’s very important that the biopsy to diagnose a bone cancer is planned together with the surgery to remove the tumor.

It is also very important that an experienced orthopedic surgeon does both the biopsy and the surgery. The biopsy needs to be done in a certain way. This gives the best chance of reducing the amount of surgery you need later on.

The main goal of surgery is to remove all of the cancer. If even a small amount of cancer is left behind, it might grow and make a new tumor or spread to other parts of your body. To lower the risk of this happening, surgeons remove the tumor plus some of the normal tissue around it. This is known as a wide excision.

What to expect with surgery

The type of surgery you have will depend mainly on the location and size of your tumor. All operations to remove bone cancer are complex, but tumors in the arms or legs are generally not as hard to remove as those in the jawbone, at the base of the skull, in the spine, or in the pelvic (hip) bone.

Before surgery, your surgeon and anesthesiologist should review the benefits and risks of the planned operation. An anesthesiologist is a doctor who gives you medications to keep you asleep and comfortable during surgery.

The short-term complications of surgery can include reactions to anesthesia, bleeding, blood clots, pain, and infections. Longer-term complications will depend on your specific surgery.

Ask your surgical team any questions you have about your surgery and recovery.

Lab tests after surgery

After surgery, a doctor called a pathologist will look at the removed tissue to see if the margins (outer edges) have cancer cells.

• Positive margins: If cancer cells are seen at the edges of the tissue, the margins are considered positive. Positive margins can mean that some cancer was left behind.
• Negative margins: When no cancer cells are seen at the edges of the tissue, the margins are said to be negative, clean, or clear. A wide excision with clean margins helps lower the risk that the cancer will come back.

Surgery for bone tumors in the arms or legs

Tumors in the arms or legs might be treated with either:

• Limb-salvage (limb-sparing) surgery: removing the cancer and some surrounding normal tissue but leaving the limb basically intact
• Amputation: removing the cancer and all or part of an arm or leg

Rehabilitation (rehab) after surgery

This may be the hardest part of treatment, and it cannot be described here completely. It may be helpful to meet with a rehabilitation specialist before surgery to learn about your options and what might be required after surgery.

Rehab after an amputation typically takes less time than rehab after limb-sparing surgery. For example, if the tumor is on a leg bone:

• After leg amputation people often walk again in 3 to 6 months.
• After limb-salvage surgery it takes about a year on average for people to learn to walk again.

Physical rehab is also much more intense after limb-salvage surgery than it is after amputation, but it’s still extremely important. It’s very important that you engage in your rehabilitation program after surgery. Actively participating will give you the best chance of keeping function in your salvaged arm or leg so it doesn’t have to be amputated later.

Surgery for bone tumors in other parts of the body

Managing your emotional health after surgery

Many people also worry about the physical differences they will have after surgery and how this might affect their social or emotional health.

When you experience changes to the way your body looks and functions, this can have a big impact on your daily life. As you navigate life after treatment, your cancer care team can give you resources for support when you need it. Keeping a positive outlook is important for your overall health.

Curettage (intralesional excision)

Some types of bone tumors are less likely to spread or to come back after treatment. In this case, the surgeon might scrape out the tumor without removing a section of the bone.

This is called curettage (intralesional excision). It is done with a sharp instrument called a curette, and it leaves a hole in the bone. After removing as much of the tumor as possible, the surgeon might treat the nearby bone tissue with other techniques such as chemicals or extreme cold (cryosurgery) to try to kill any remaining tumor cells.

Bone cement

After curettage, bone cement can be placed to fill the hole and strengthen the remaining bone. The bone cement PMMA (polymethylmethacrylate) starts out as a liquid and hardens over time. It can be put into the hole in the bone in liquid form after curettage. As it hardens, it gives off a lot of heat, which might help kill any remaining tumor cells.

Surgical treatment of bone tumor metastasis

If bone cancer has spread (metastasized) to other parts of the body, these tumors need to be removed to have a chance at curing the cancer.